A decade of bad breath, glad I found this place

[Zed]

Hi all,

I've suffered from bad breath for at least seven years that I've known about, and probably more like my entire life judging by random off-the-cuff remarks I've mostly forgotten about. It's not as horrible as some of the problems I've heard; I'd call it mild to moderate. But it's still bad enough that my girlfriend told me about it 7 years ago. The wonderful lady that she is, she's lived with it and we've been married for 3 1/2 years now, but I owe it to her (and myself) to figure out how to fix it. So here I am!

Stuff I've tried:
- First stop was the dentist. Three straight semi-annual cleanings with two different dentists yielded little. They didn't seem to think much of it, although the first mentioned to keep the flaps near my wisdom teeth clean. Been brushing/flossing twice a day ever since.

- Next was a gastroenterologist. Had an abdominal sonogram which yielded nothing, and a bunch of blood work looking for Celiac (nope) and a ton of potential allergies (nope).

- Then went to a nutritionist, who used a series of breath tests to try to figure out if I had a food sensitivity. The fructose test turned up nothing, but the sucrose test supposedly came up positive. However, the way the test was conducted was sketchy at best, and I doubt it was ever properly calibrated. Bottom line, six months of cutting sugar out of my diet and taking a strong probiotic resulted in me losing 25 pounds, but no other benefits, and definitely not better breath.

- Next stop was about a year later, and that was an ENT. She did the camera-through-my-nose bit, told me I had a deviated septum but nothing to worry about, and that my tonsils looked "fine, but a little ratty." She seemed decent enough, and turned me on to nasal irrigation. Been doing it daily since, and have definitely noticed better breathing and a much better track record with colds, but (again) no noticeable improvement in my breath.

After that, I'm sorry to say that I got lazy with it again. However, since I found this site earlier tonight I've gotten a lot of hope, for a few reasons.

I should point out that the one time in seven years that my wife said the breath problem was gone was when I was on an antibiotic for a sinus infection. I'm about 90% sure it was Clarithromycin (Biaxin), but it could have been Amoxycillin. I'm not certain about that. Regardless, some posts here say that this points to something bacterial in nature, but I'm not sure where to look.

Some points:
- Poking into my flaps and leaving my finger there for a bit doesn't yield an odor when I take it out.
- I don't appear to have tonsil stones. Also, I can poke my tonsils with my finger and it yields no smell.
- I never taste anything too bad in my mouth. Sometimes a "morning taste" but the breath is bad regardless of how my mouth tastes.
- Saliva-on-the-hand test yields nothing, even after a few minutes.
- The breath problem exists through both my mouth and nose. At a given time, if my mouth is a 9-10, my nose will be around a 6-7.
- I have tried brushing my tongue but my gag reflex always made it difficult to do for a long period of time. I was doing it for some time but no improvement. It may be better now, it's easier to suppress the reflex now that I've been irrigating for almost a year.
- I have had a root canal on my upper-left first molar, and fillings in the same tooth in the other three corners of my mouth.
- My bottom wisdom teeth are just about completely in, and have been for some time. My top ones don't even seem to exist. They could be in there somewhere, but they neither penetrate out nor bother me.

From reading the site, I think in the next few days I'm going to try both the Waterpik and the Stage 2 irrigation. Frankly, the irrigation sounds like fun; I'm completely used to the Stage 1 at this point and didn't know it went farther.

I'll continue reading here and hope to make some progress, and I sincerely hope the rest of you find your solutions as well. If ANYONE has ANY suggestions, I'd be thrilled to hear them.

Glad my random Google search brought me here!

[halitosisux]

Hi there. You dont mention whether your tongue has any odour to it. Its normal to have some odour, there's billions of bacteria sitting on there and and a constant supply of nutrients for them, but if there's problems it doesnt take a lot for the odour level to exceed a threshold that leads to your breath smelling bad. If your tongue smells very bad, then its likely to be contributing to your problem at the very least.

Is your post nasal drip typically clear or coloured?

Root canals can cause BB if they havent been done perfectly. Also you should ask for an xray on your upper wisdom teeth, which by the sound of it are unerupted and might possibly be causing problems with your sinuses or adjacent teeth.

The odour could be coming from your lungs. If you live in the UK you should ask for a free TMAU test.

Read this:- viewtopic.php?t=3495&postdays=0&postorder=asc&start=0

There are other common digestive problems which can cause odour to come from the lungs, which you havent mentioned, and you need to get these ruled out too.

[Zed]

Thanks for the response. I'll answer as completely as I can.

- Front of my tongue has no coating and giving it a rub/scratch right now with my finger yields something that doesn't smell much like anything, although I pick up a faint toothpaste smell. I brushed 4 hours ago, wasn't expecting that. Doing the same thing on a different finger further back yields a mild fecal smell, although nothing overbearing. Could be on to something though. There's more white coating toward the back. FYI, I brush twice daily with Colgate Total, and I've tried using a tongue scraper for several weeks with no improvement.

- When you talk about the PND, are you referring what falls into the back of my throat? If so, I'm not really sure how I'd check that. I don't completely understand the entire mechanism of PND... does it stay along the wall/roof of my throat, or does it literally drip, etc? And is it something I could identify from my nostrils or tongue? What I can tell you is that I occasionally get brownish and yellowish colors in my snot and irrigation (stage 1) runoff, the occasional reddish too. I also know I have a deviated septum, but it hasn't led to any real breathing issues. If the above tongue odor issue is related to this, then my attempts at stage 2 irrigation starting today could yield something.

- My root canal was done 15 years ago, when I was 12. And it was done in 5 go-arounds. I think it was pretty thorough; I've had zero issues with that tooth since and poking around the area yields no odor.

- I'm going to my dentist next week for a cleaning and checkup, so I'll ask for the x-ray then.

- Hadn't heard of lung odor, but reading a little about TMAU, I'm not sure because I don't have any other strange body odors. You know, other than the standard ones if you don't shower one day

In my reading, I also read more about the halimeter tests. Personally, I thought the way it was done with me was very arbitrary, but I could be wrong. Empty stomach yielded a reading of 5 (ppm, I think?) I remember that the fructose test was to drink a can of soda at 5am and test at 8am, and that test yielded a 2. The sucrose test was 2 tsp of sugar in 8 oz. of water at 5am, test at 8am, and that yielded an 8 or a 10.
However, even on an empty stomach, I found I varied between 2 and 10. 5 was the cutoff for a "sensitivity" to that food; whatever's going on seems to be regardless of what's in my stomach.

Any insight appreciated, as usual.

[halitosisux]

You're welcome. Yes PND is what drains from the back of the nose. A normal nose drains about a pint of mucus down the throat every day, along with the mucus produced by the mucous membranes that line the nose and throat. This is a normal and essential protective function.

If you have allergies or a deviated septum (as I do) you become very conscious of excessive drainage and the constant need to swallow or clear it. This is not generally the case for a normal drainage. Also, if you have an infection or you've just got over a cold, when your mucus tends to thicken, you'll feel an almost constant need to "snort" or blow that mucus out. Its quite possible that this type of thickened mucus clings to the back of the tongue and throat and increases the amount of bacterial activity and odour there, especially if the mucus is already smelly and infected. A sign of this is when the mucus is coloured brown or green.

Thickened mucus may even be what causes tonsil stones to form by causing stagnation inside the tonsil crypts by blocking them off. Most people with tonsil stones tend to also have PND, so this might be the connection.

TMAU is commonly referred to as fish odour syndrome and the relatively few people who've even heard of it generally associate it with smelling of rotten fish and having body odour which can stink a whole house out. This is certainly true in the very rare and extreme forms of TMAU in which the body has almost zero ability to deal with the trimethylamine that has been produced by the bacteria in the bowels and be absorbed and allowed to build up to high levels in the bloodstream. But, there other manifestations of this problem that can allow this chemical to build up, even at much lower levels which are still able to cause problems with odour. And at low concentrations, Trimethylamine has a fecal and garbage-like odour. It can smell of a whole range of bizarre chemical-like odours. Bad breath is sometimes the ONLY symptom. It can be released from the lungs and be secreted in saliva and other bodily secretions.

It might be worth trying out some of the measures that TMAU sufferers use to try to control their problem, to see if it has any effect. Charcoal, specific diet, etc.

You should also ensure that you are not infected with helicobacter pylori. This can be determined by your doctor with a simple blood test. At the same time, ask for liver and kidney blood tests to check their function, along with any other tests that your doctor thinks are worth trying, such as for celiac disease and parasites.

[MissPretty]

Zed; deviated septum can cause bad breath

[Maz]

Hi Zed,

I think I have got exactly what you have, just I've only had mine (that I know of) for around a year. It's got to the point now that I'm so low about it I'll try anything!!

I only get mine 2-3 times a month though and when I do it lasts around 2 days. Is yours permanent?

So far I've done the dentist trip, and nothing there.

I've cut everything smelly out of my diet, and started using anti-biotics and no change there either.

I recently bought sinus drops from Therabreath as twice I got it when I had painful sinuses (other times it's just random). And they actually get rid of it if you take enough. But still I don't know when I have it so it's not too helpful once I come home and my partner tells me I have it... As then it's too late!!

My doctor recently came me steroid nasal spray, that hasnt worked either.

I'm so paranoid now, I chew constantly, but as it's from the nose also you can still smell it. If you find anything that works or have any ideas for me to try Please tell me!!

[Zed]

This weekend I tried a couple of things with limited success. First, I found out a couple of specifics: the breath isn't as bad when I've eaten recently, and also when I've been drinking anything alcoholic.

First I got a baseline, about four hours removed from dinner and just prior to brushing/flossing in the evening. 10 being the worst, she gave my mouth breath a 9 and nose breath a 6.

The next morning, we ate breakfast and then I did a few things: First I took a shower and did stage 1 irrigation, followed by a reasonably successful attempt at stage 2. It's going to take some practice but I think I can get the hang of it. Immediately after, I used a new tongue brush I had just gotten (not scraper) and brushed my tongue fairly thoroughly, as far back as I could. I also brushed thoroughly, as far back as I could in my mouth, and spent more time flossing than usual. I did not use mouthwash, for the first time in a couple of years.

After this, I did another sniff test and I was sitting at a 2 from my nose and 4-5 from my mouth. Later in the evening, after dinner, drinks, and another tongue brushing, it was a 1 from my nose and a 3 from my mouth. I suspect that the combination of stage 2 irrigation and tongue brushing is at least addressing the end results of a foul-smelling PND issue. I'm going to keep it up and see if the good results continue.

Sux:
I could say that I'm conscious of a lot of drainage. Because of the deviated septum, I end up with a difference in stuffiness between my nostrils, but one or the other frequently feels a little backed up. I wouldn't call it a constant need to clear my throat, but it does seem to be more than your average person.

I am going in to see my doctor today and I'm going to ask for the H. Pylori test; that one strikes me as a distinct possibility. My liver function indicators were fine as of my last checkup a month ago, but I'll ask about any kidney tests I can do. I was tested for celiac last year and it came up negative.

Maz:
Mine is permanent in that it doesn't just come and go in short spurts, but it's definitely not 100% omnipresent. As I said above, eating sometimes diminishes it a little, a couple of alcoholic drinks can diminish it quite a bit more, and a 10-day course of clarithromycin (Biaxin) made it completely disappear until around five days after the last dose. Those are pretty much the only things I've been able to pin down.

From what I can tell, antibiotics may not work unless they're one of a few specific combinations. Biaxin worked, but I was taking it to get rid of a sinus infection, not cure my breath issues. Also, I took Prilosec (omeprazole) for a couple of months and that had no effect at all. The dentist has yielded nothing, obviously. I've gotten very good with my dental hygiene but that hasn't affected things at all.

If you've linked the issue at all to your sinuses, and you don't do it already, I strongly recommend nasal irrigation with either a squeeze bottle (my personal preference) or a neti pot. At absolute worst, it will drastically improve any sinus issues. I was weirded out by the idea at first, but once I tried it I had no idea how I'd ever gone without it.

Will report back after appointment(s).

[Zed]

Ooh, another small but important point in this post which points straight at H. pylori as a potential root of my issue:

"Antibiotics. Amoxicillin, a semi-synthetic penicillin, is an effective antibiotic for H. pylori infection. The frequency of amoxicillin-resistant H. pylori organisms is low. The drug rapidly accumulates in antral mucosa via systemic circulation. Its antimicrobial activity against H. pylori depends on the pH level; the minimal inhibitory concentration (MIC) decreases as the pH increases.29 Clarithromycin is also quite effective, although more resistant organisms are emerging.30 Co-administration with a PPI significantly increases the concentration of clarithromycin in the antral mucosa and the mucus layer. Erythromycin and azithromycin are much less effective macrolides in vivo and should not be used in H. pylori treatment."

As I said above, a regimen of clarithromycin effectively eliminated my bad breath until a few days after my last dose. However, the next time I had an infection, I was prescribed Zithromax (azithromycin) and it had no effect at all on my breath. Maybe it's all coming together? /pray

[halitosisux]

Someone else recently said that Therabreath nose drops works well for their nasal BB.

Zed, sinus infections tend to clear by themselves normally, so the fact that you needed antibiotics may indicate that there is some underlying vulnerability that not only exposes you to developing chronic sinusitis, but also for problems to develop that lead to BB. A deviated septum is an example of such a vulnerability. Also, nasal irrigations are unlikely to make any difference unless your nose itself was a source of odour, so the fact that they do make a difference is a good sign.

Nasal irrigations can sometimes make the problem worse for some people. But the fact it has any effect at all is the important thing.

Its very difficult to pinpoint or conclude anything when antibiotics improve your BB. But you are going the right way about it by ruling out everything you can by trial and error.

[Zed]

Update:

Negative on the H. pylori. Doctor has offered to give me a 7-day prescription of Metronizadole anyway if I really want, but warned that "it's pretty nasty stuff" and they don't like prescribing it unless they have to. Haven't accepted, but can go back anytime if I want to.

Anyway, over the past two weeks, I haven't been using Listerine, have been using the Tung brush every day (the Bermuda-grass type bristles are amazing) and have been taking my best stab at stage 2 irrigation with my squeeze bottle every 1-2 days. Still working on my technique.

The good news is that the combination still seems to be working. The root of the issue definitely appears to be in the nose somewhere, because I haven't really changed anything in my routine except for the above, and my average breath is down from a 9 to maybe a 3-4.

I'll keep at what I'm doing now while I keep looking into the source of the problem. I got a tip to look for enlarged turbinates (concha bullosa) and to see an ENT about getting a CT/MRI for it. If my current methods keep working, I may just build on those to avoid surgery, but at least finding the cause would be a major help.

Thanks again for all the tips.

[WickedCurse]

Thank you Zed for the updates. Keep it up please.